Healthcare Provider Details

I. General information

NPI: 1841550035
Provider Name (Legal Business Name): VIRGINIA BARIATRIC SURGERY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850A TOWN CENTER PKWY SUITE 301
RESTON VA
20190-5851
US

IV. Provider business mailing address

1850A TOWN CENTER PKWY SUITE 301
RESTON VA
20190-5851
US

V. Phone/Fax

Practice location:
  • Phone: 703-709-9771
  • Fax: 703-709-8084
Mailing address:
  • Phone: 703-709-9771
  • Fax: 703-709-8084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101250534
License Number StateVA

VIII. Authorized Official

Name: DR. MATTHEW ALEXANDER FITZER
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 703-709-9771